# Narrative foreclosure among patients with chronic diseases: a scoping review

## TL;DR

This review explores how patients with chronic diseases experience narrative foreclosure, a sense that their life story has ended, and identifies factors and interventions related to it.

## Contribution

The study provides a first scoping review on narrative foreclosure in chronic diseases, highlighting variations across conditions and intervention strategies.

## Key findings

- Narrative foreclosure is described as a belief that one's life story has ended, with differing manifestations across chronic diseases.
- Twelve factors, including age and social support, are associated with narrative foreclosure.
- Interventions such as hope theory and dignity therapy are used to address narrative foreclosure.

## Abstract

To comprehensively integrate existing research on narrative foreclosure among patients with chronic diseases, aiming to explore how the concept is described and whether its clinical manifestations differ across various disease contexts, as well as to summarize the associated factors and intervention strategies.

Scoping review.

Systematic searches were performed in seven databases (CNKI, Embase, PubMed, CINAHL, PsycINFO, Scopus, and Web of Science) from their inception until March 2025.

We followed the framework proposed by Arksey, O'Malley, and Levac. The review was reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension. Research on narrative foreclosure in patients with chronic diseases was included, regardless of the specific setting in which it was conducted.

A total of nine studies were included, covering both cancer and other chronic diseases. The primary outcomes are as follows. The core concept of narrative foreclosure in the context of chronic diseases refers to a state in which individuals believe their life story has ended; however, its specific descriptions vary across chronic diseases such as asthma and depression. The clinical manifestations include negative emotions and maladaptive behaviors. Twelve associated factors were identified, including age, psychological factors (such as ego integrity and hope), social support, and educational level. Interventions targeting narrative foreclosure involved the application of hope theory, dignity therapy, meaning-centered approaches, and narrative nursing.

At present, research on narrative foreclosure in the field of chronic diseases is limited. Narrative foreclosure has been proven to have adverse effects on disease management among patients with chronic diseases. Therefore, it is particularly important to pay attention to the clinical manifestations of patients' narrative foreclosure and to identify the factors that promote or hinder it. Additionally, existing intervention measures need further verification, and the concepts of positive psychology should be integrated into their design and implementation.

Our review protocol was prospectively registered on the Open Science Framework (OSF). Unique Identifier: 10.17605/OSF.IO/5RQKM.